Aim: This study explored the association between the diet diversity score (DDS) and overweight among Tunisian children.
Methods: A representative sample of children living in Greater Tunis was selected based on a two-stage clustered sampling design. A total of 1200 children (3-9 years) were recruited. Dietary assessment was realized using a 24 h dietary recall. Anthropometric measurements were realized, and overweight was defined according to the World Health Organization standards. Logistic regression was used for the association between DDS with overweight.
Results: A quarter of children were found to be overweight. Overweight prevalence was found to decrease with the increase of mother education level (p = 0.010) among children <6 years. Crude DDS score was higher among non-overweight children irrespective of the age class (p = 0.002). Tunisian children appeared to consume much more than six food groups, corresponding to a more than recommended intake of most nutrients. Intriguingly, DDS was positively associated with the occurrence of overweight children <6 years, adjusted odd ratio = 1.37, 95% CI (1.03-1.82).
Conclusion: Overweight is a public health problem among Tunisian children. A high DDS signifies adequate nutrient intake. An increase of DDS was found to be a positive predictor of overweight only in pre-school children.
Keywords: Tunisia; childhood; diet quality; low- and middle-income countries; nutrients; obesity.